Best practices in ASD Assessment 1

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Dr. Kristine Strong, gives best practices in ASD Assessment. Dr. Strong is a Licensed Educational Psychologist in Northern California.

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  • Who is in the audience -- who have started teams?
  • Autism is a very heterogenous disorder -- Three types of autism - R. Hansen, there seems to be three distinct subtypes or endophenotypes and several mechanisms of autism, Early Onset, Regression-Both Social and Language, Regression-Either Social or Language
  • New rates suggest 1 in 150 last year, to now less than 1 in 100
  • To highlight the wide range of needs and issues for children on the spectrum -- dvd -- the many faces of autism
  • Leo - make point that resolved without going to due process
  • Assessment areas depend on referral concerns, ie., not always need OT
  • Also important to note regression in either or both language/social
  • LUNCH BREAK
  • From the National Autism Center, 2007 report
  • kaden
  • Autism Faces - DVD
  • PARENT EDUCATION WORKSHOP-- will be available through mind online next year.
  • Example of J.M. IEP --
  • Best practices in ASD Assessment 1

    1. 1. Assessment of Children with Autistic Spectrum Disorders: Best Practices for Educators Kristine Strong, Ph.D.,LEP #2314 Copyright 2012
    2. 2. Goals of the Workshop Increase knowledge and awareness of effective assessment tools and methods for ASD Develop understanding about multidisciplinary assessment teams Develop understanding about the importance of the parent - school relationship and working effectively with parents Learn about current evidence based practices Develop skills in IEP development
    3. 3. ASD Is A “Spectrum” Disorder “Spectrum” ranges from mild (more able) to severe (less able).  Mild = High-functioning Autism (HFA), Asperger’s Syndrome, PDD, PDD-NOS  Moderate = Classic Autism (As described by Kanner)  Severe = Autism with other collateral conditions such as MR and seizures, Retts Disorder(females only), Childhood Disintegrative Disorder (rare), Landau-Kleffner Syndrome. 3
    4. 4. Statistics Autism is increasing at an alarming rate.  Department of Developmental Services study: rates of autism have risen 210% in the past 10 years.  Increase of over 600% for Special Education eligibility under the autism category from 1994 to 2003 (US Dept of Ed). 4
    5. 5. Why the Increase? 1975 Education of the Handicapped Act identified “autism” and “pervasive developmental delay” as disabling categories. Prior to that change persons were labeled as MR. DSM IV broadened the disability to include PDD-NOS, Autism and Asperger’s Syndrome. 1990 IDEA made autism a qualifying disability category. Many studies being conducted, with a causation model including both genetic predisposition and environmental variables -- no one cause likely 5
    6. 6. The Anatomy of AutismNeuro-imaging (fMRIand PET scans)indicate location ofpathologyMultiple brainsystems and brainfunctions areimpacted by thisdisorder
    7. 7. Three Types of Autism? Center for  Autism is considered to Excellence in have a strong genetic Developmental component. Disabilities UC  Pattern of onset may be related to specific type Davis MIND of autism: research:  Predominant language Interactive models regression  Predominant social of ASD include regression multiple  Early onset in both social environmental and language variables and gene development interactions.
    8. 8. Deviation In: Hippocampus and amygdala (emotional regulation and memory) Cerebellum (motor coordination, shifting attention, concept formation, sequencing, working memory, complex problem solving, sensory discrimination)
    9. 9. Deviations In: Brain stem (brain/body communication, basic functions) Brain size, growth pattern, and white matter (axons -cables connecting brain cells) Brain microstructures, minicolumns are narrower and made up of smaller cells vs. normal brain Neocortex  Particularly frontal lobe (higher level thinking and executive functions, early speech acquisition, and integration of information)  temporal lobes (auditory processing)
    10. 10. Understanding Autism SpectrumDisorders Neurobiological differences lead to deficits in social perception, theory of mind and social relatedness, that in turn lead to problem situations for group learning, peer interactions, and student-teacher interactions in school. Problem behaviors are a result of known neurobiological differences and environmental influences but can be addressed through active, direct teaching of adaptive social skills and problem solving skills.
    11. 11. Social-Emotional Implications ofautism spectrum disorders Few or no close friends--limited social interests Avoidance of socially demanding situations Difficulty sensing or interpreting emotions in self and others Greater likelihood of also having anxiety and/or depression
    12. 12. Social and EmotionalImplications Impaired non-verbal communication, including limited facial expressions Impaired pragmatic language, including lack of cohesion to conversation
    13. 13. Impaired Executive Functioning An inability to engagein goal-directed, future-oriented behaviors including:planning, flexibility, organizedsearch, self-monitoring, anduse of working memory.
    14. 14. “Behavior Problems” Associated WithExecutive DysfunctionNoncomplianceOff Task Behaviors/DistractibilityInflexibility or RigidityProcrastinationPrompt DependenceDisorganizationSocially Inappropriate Behaviors
    15. 15. Understanding HFA & AD cont. Deficits in working memory, attention, and executive functioning, such as organization and planning, can lead to increased stressors in school, difficulty completing work, and escape and avoidance behaviors. Remember, behaviors happen for a reason and are likely in large part a symptom of these underlying deficits and lack of adaptive skills to respond to these deficits.
    16. 16. Model of Problem Behaviors Core Neuro - Lack Development Adequate al Deficits supports Problem Behavior Poor Poor Social Coping Skills Skills
    17. 17. California Code ofRegulations 3030 g:A pupil exhibits any combination of the following autistic like behaviors, to include but not limited to:  An inability to use oral language for appropriate communication. A history of extreme withdrawal or relating to people inappropriately and continued impairment in social interaction from infancy through early childhood.
    18. 18. California Code cont.: Anobsession to maintain sameness. Extreme preoccupation with objects or inappropriate use of objects or both. Extreme resistance to controls Displays peculiar motoric mannerisms and motility patterns. Self stimulating- ritualistic behavior.
    19. 19. DSM IV Diagnosis of Autism SpectrumDisordersA. 1. Social Interactions (Must have at least 2 of the following)  Impaired use of nonverbal behaviors  Impaired peer relations  Limited sharing of enjoyment  limited social or emotional reciprocity 2. Communication (Must have at least 1 of the following)  Delay of development of spoken language  Impairment in conversation  Repetitive use of language or idiosyncratic language and prosody  Lack of varied make believe play 3. Restrictive and Repetitive/Stereotyped Patterns of Behavior (Must have at least 1 of the following)  Restricted interests  Adherence to nonfunctional routines  Stereotyped motor mannerisms  Preoccupation with parts of objects 19
    20. 20. DSM IV Diagnosis for Autism Cont.B. Delays or abnormal functioning in at least one of the following areas: 1. Social Interaction 2. Language as used in social interactions 3. Symbolic or imaginative play The disturbance is not accounted for by Rett’s or Childhood Disintegrative Disorder. To be diagnosed with Autism, at least six symptoms from A (at least two from A1 and one each from A2 and A3), one from B, and C must be present. To be diagnosed with PDD-NOS, disorders will be apparent in all areas (A-C), but some will be atypical or sub-threshold. This disorder is often recognized later than autism. 20
    21. 21. DSM IV Diagnosis of Asperger’sSyndrome (AS) A. Social Interactions (Must have at least two of the following)  Impaired use of nonverbal behaviors  Impaired peer relations  Limited sharing of enjoyment  Limited social or emotional reciprocity B. Activities and Interests (Must have at least one of the following)  Restricted interests  Adherence to nonfunctional routines  Stereotyped motor mannerisms  Preoccupation with parts of objects 21
    22. 22. DSM IV Criteria for Asperger’s Cont... C. The disturbance causes clinically significant impairment in social, occupational, or other important functioning. D. There is no clinically significant general delay in language (e.g. single words used by age 2, communicative phrases by age 3). E. There is no clinically significant delay in cognitive development or in the development of age appropriate self help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood. F. The criterion are not met for other specific Pervasive Developmental Disorders or Schizophrenia. 22
    23. 23. Autism - utube videosSamples of autistic like behaviors
    24. 24. What is Different about the Assessmentof ASD vs. other EducationalCategories? More comprehensive because of the pervasive nature of the disorder Requires more specialists and service providers, requiring increases in communication and collaboration-- systemic challenges An ASD requires more specialized services and increasingly more demands on educators to develop expertise in autism specific strategies
    25. 25. Educators Responsible for Ed.Code Eligibility Although the DSM-IV criteria are important to know and use as a reference for determining “autistic like” behaviors, educators do not diagnose using the DSM-IV. Autism specific measures use the DSM- IV diagnostic criteria as a part of their content validity - so need to be knowledgeable about DSM-IV criteria
    26. 26. What is Different cont.: Adaptations for standardized tests, including use of structured reinforcement Increased use of non-standardized assessment methods, including both natural and structured observations Critical to differentiate between ASD and other disorders, such as ADHD, Emotional Disturbance, and Language Disorders-- course of educational planning is different
    27. 27. Team Activity What are the core deficits in children with ASD? What do you already know about how to evaluate those areas? What parts or aspects of ASD assessments do you believe are the most challenging?
    28. 28. Case Study: Bobby V. Transitioning from Early Start 2 years - 10 months Recent dx of ASD Highly verbal Bright Concurring assessment by NPA Advocate already involved
    29. 29. Case Study cont. Priority on parent-district relationship Home visits, natural environment was primary assessment setting Critical to respond to parent concerns Language evaluation utilized a range of tools - on the surface he looked fine Teaming was critical - the team was able to identify core deficits and needs- got agreement on our assessment
    30. 30. Goals of Assessment: Why do weassess? Establish eligibility under Ed. Code. Identify student unique needs that will lead to specific goals and objectives Understanding unique needs directs team when determining FAPE
    31. 31. Good Data = Good Planning  Team who is knowledgeable about the child develops trust and credibility with agencies and families  Develop appropriate intervention plans
    32. 32. The AutismAssessment/Intervention Team TeamMembers should include a Behavior Analyst, Behavior Specialist, Speech Therapist, Occupational Therapist, Classroom teacher, Special Education Teacher, Nurse, School Psychologist and Administrator.
    33. 33. The Assessment Process: DevelopmentalAreas and the Trans-Disciplinary Model Specialists collaborate to provide a multi- method assessment across developmental areas Trans-disciplinary teams design assessment tasks and activities together for mutual benefit The TDT generates rich information about the child leading to meaningful goals, integrated services, and a meaningful report to parents
    34. 34. Assessment Areas Health and Medical  Social - emotional Behavioral  Cognitive assessment- functioning baseline of behaviors that  Adaptive Behaviors interfere with  Communication learning  Pre-academic and Fine and Gross academic areas Motor Sensori-Integration
    35. 35. Assessment Methods Developmental  Standardized health history Assessments Natural  Parent Interview Observations  Review of Structured records/reports Observations
    36. 36. Developmental and MedicalHistory Initialeligibility assessment requires extensive parent interview about the child’s early development and medical history. Important to gather data on early signs of ASD, including, lack of gestures, little or no babbling, delayed language, lack of pointing, lack of interest in children, limited shared attention, lack of eye contact during feeding and games.
    37. 37. Developmental History cont.: Feeding or sleeping problems Unusual sensory reactions, ie., noise or touch Unusual focus or attention toward limited areas of interest Range of affect, flat vs. full range Verbal and nonverbal forms of communication--intent to communicate needs Unusual motoric movements Fine and gross motor development
    38. 38. Natural Observations Occur in several settings such as home, preschool/school or child care Take place with no structured activities other than those that occur naturally within the setting Important to observe on more than one occasion and by multiple observers When possible, chose one or two “controls” to observe in relation to student, ie., Tommy completed the task at the same pace as his peers, but needed twice as many prompts
    39. 39. Structured Observations-PlayBased Structured observations provide specific tasks to be performed, such as putting puzzles together, imitation tasks, and pretend play activities Activities are play based - interactive
    40. 40.  Specific behaviors are elicited, including  Reciprocal turn taking  Pretend play  Social reciprocity  Imitation of novel acts  Ability to be directed by examiners  Use of toys and objects  Use of spontaneous language  Quality of spontaneous and prompted verbal and nonverbal communication  Play imitation  Joint referencing  Eye gaze, following a point  Eye contact, seeking eye contact to gain attention of others
    41. 41. Play-based assessment Toys and materials  Develop a play of interest to child’s based assessment age or mental age box or “tool kit” Variety of toys to  Include toys that are engage and illicit sensory based, interest symbolic play, cause Include books, and effect, can be musical toys, balls, used to prompt cars, pretend play imitation
    42. 42. Standardized Assessments: Usesand Limitations Standardized assessments provide objective data about broad functioning and abilities in specific developmental areas. Important to cross reference standardized results with observation data and interview data to make relevant, as well as to point out where there are discrepancies.
    43. 43. Limitations toStandardized Tests ASD children often do not perform well on these types of measures, and therefore they can underestimate their ability Reliability is also an issue due to highly variable performance of skills Note in your report the specific limitations of the results.
    44. 44. Parent Interview for InitialEligibility Can be structured or informal -- strongly recommend including a home visit. Use of structured interviews such as The Autism Diagnostic Interview, R (ADI-R) (can be used for children through adults) is critical for establishing clear developmental clusters consistent with ASD.
    45. 45. Family Centered  Family centered format--this is often the first impression the family gets of educators.  Highly sensitive time for parents, make sure you provide ample time to answer their questions.
    46. 46. The Faces of AutismParent perspectives reflect thewide range of needs of children with ASD and highlight the individual nature of autism.
    47. 47. Areas to Assess: Core Deficits Reflect - what are  What will most the core deficits? assessment plans Comprehensive need to consider? evaluations need to  Develop include all areas assessment plans related to a with parent input. suspected disability
    48. 48. Team Assessments  Set up stations such as, fine motor, pretend play, academic, sensory  Tag team - take turns observing and evaluating  Tag team - one team member with parent, two with child and then rotate.
    49. 49. Cognitive Assessment Use good  Note the type of comprehensive support needed to tools: DAS-2, learn a new task -- WPPSI-2, KABC-2, how many trials Consider using does the child need processing tests, ie., to learn new WRAML-II for older information? children,and NEPSY  Note processing - can use with 2 1/2 profiles, visual year olds, DAS-2 memory vs. verbal
    50. 50. Cognitive cont. With young children  Focus on the between 2 and 5, cognitive functioning important to explain and how areas of validity of results - deficit may impact IQ or cognitive learning, ie., verbal functioning is not yet processing deficits stable and can likely to impact change especially ability to take following intensive teacher instruction program in a large group
    51. 51. Cognitive cont.  Important to let parents know the possibilities, such as mental retardation,processing challenges, while at the same time recognizing that cognition is difficult to determine at a young age, and need to see how child will respond to intervention.
    52. 52. Case Study: Mark Six year old still in preschool NPA program Transition to school Standardized evaluation difficult Standardized results indicate moderate MR, however, adaptive skills and academic skills indicate much higher functioning. Following transition, child is now reading and able to access general education setting.
    53. 53. Adaptive Behavior Parent and teacher interview are integral to a comprehensive assessment and often lead to specific needs to generate goals and objectives. Cross reference adaptive behavior with other areas of functioning -- are there discrepancies? How much support does the student need to perform these tasks? Use standardized questionnaires, such as Vineland, to establish baseline and to provide objective data on the student’s development.
    54. 54. Fine and Gross Motor Fine and gross motor deficits are often deficit areas in children with ASD, often requiring direct assessment and intervention. Occupational Therapists are best equipped to provide a comprehensive assessment of these two areas, in addition to sensory issues. Observe child’s grasp, use of writing and drawing tools, visual-perceptual issues, motor planning, and ability to keep up with written motor tasks - pace of instruction.
    55. 55. Behavior & ASD SpecificMeasures: Use of standardized measures:  BASC-2  Achenbach Child Behavior Checklist  Childhood Autism Rating Scale - 2 (CARS-2)--very strong validity  Gilliam ARS (moderate validity)  Social Responsiveness Scale -ages 4 and up  Autism Diagnostic Observation Schedule (ADOS)  The Autism Diagnostic Interview-R (ADI-R)-- highest validity
    56. 56. Determine Interfering Behaviors Observation and data collection:  Target behaviors, or interfering behaviors, level of intensity, frequency, impact on learning  Critical to gather baseline data on target behaviors, determine if a BSP is needed or FAA
    57. 57. Tools Looking at“Autistic Like Behaviors”Solid Psychometric Support Adequate Support The Autism Diagnostic Autism Diagnostic Interview-R (ADI-R) Observation Schedule (ADOS) Social Communication Child Behavior Checklist (CBC) Questionnaire (SCQ) Psycho-educational Profile -RSufficient Support (PEP-R) Childhood Autism Rating Modest Support Scales (CARS) Autism Behavior Checklist Social Responsiveness Gilliam Autism Rating Scales Scales (SRS) (GARS) Asperger’s Syndrome Diagnostic Interview (ASDI)
    58. 58. A Closer Look at the CARS 2  CARS 2 has high reliability and validity  Utilizes three data points: observation in multiple environments, parent survey/interview/ and teacher survey and interview
    59. 59. Group Think Sample Reports:  Jigsaw in groups of 3  How are ASD specific issues addressed?  What would you add/change?  Your concerns questions about addressing ASD specific behaviors
    60. 60. Assessment Environment “When clinically indicated, observations of a child in various settings and at different times increases the validity of information obtained and assists in diagnosis, case management and intervention.” Looking at the child in multiple environments is beneficial and necessary Home, preschool, playground, backyard, daycare, school/clinic Collaborative assessment with other team members allows for better observation/data collection Autism Spectrum Disorders: Best Practice Guidelines for Screening, Diagnosis and Assessment California Dept. of Developmental Services 2002
    61. 61. ASSESSMENT TOOLS: Direct/Standardized1. Preschool Language 5. Comprehensive Assessment Scale-4 of Spoken Language (CASL)2. Peabody Picture 6. Reynell Developmental Vocabulary Test Language Scales3. Receptive and 7. Goldman Fristoe Test of Expressive One Word Articulation-2/KLPA-2 Picture Vocabulary 8. Clinical Assessment of Tests Articulation and Phonology4. Sequenced Inventory of (CAAP) Communicative 9. Language Sample Development- Revised(SICD-R)
    62. 62. Parent Interview and Observation Tools 1.Rossetti Infant Toddler Language Scale (Linguisystems) 2.Pragmatics Profile of Everyday Communication Skills in Preschool Children (Hazel Dewart and Susie Summers ) 3.Pragmatic Communication Skills Protocol (Academic Communication Associates) 4.Functional communication Profile Revised (Linguisystems)
    63. 63. DIRECT ASSESSMENT MEASURES- LANGUAGE/COMMUNICATION SKILLS ROWPVT/EOWPLS-4 -measures Auditory PVT-measures Comprehension receptive and Expressive single Communication word/expressiv for Birth-6-11 e single word vocabulary(2-PPVT-measures 18) receptive single  SICD-R word vocabulary Receptive and Expressive portions(4mos- 48 mos)
    64. 64. Direct Assessment contCASL-Research-based, theory-driven oral languageassessment battery for ages 3-21. Fifteen testsmeasure language processing skills,comprehension,expression, and retrieval—in four language structurecategories:Lexical/Semantic, Syntactic,Supralinguistic, and Pragmatic. Subtests can “stand-alone”.
    65. 65. PRAGMATICS PROFILE OF EVERYDAY COMMUNICATION SKILLS/PRESCHOOL  Interview questions  Information gathered  Typically done in home can be helpful for with parent/caregiver parents to understand  4 domain areas: all aspects involved in communication Communicative  Information also helpful Function, Response to Communication, in identifying specific Interaction and areas of need, writing Conversation, goals and planning Contextual Variation interventionWebsite to download profile:http://wwwedit.wmin.ac.uk/psychology/pp/documents/Pragmatics%20Profile%20Children.pdf
    66. 66. Language Goals•Important to meet as a team to discuss whowill write which goals•Behavior specialists/analysts have expertisein writing ABA type goals•Language goals should not be addressedsolely in pull-out therapy –Languageopportunities happen all day!!•Important for classroom teachers/aides to befamiliar with goals and how to implement themwithin the classroom.
    67. 67. Pre-Academics and AcademicAssessment: Consider using  Note the necessary criterion referenced accommodations needed for learning measures in addition to  Does the child need frequent breaks? standardized, ie.,  Note level of frustration Brigance, AEPS, tolerance. Hawaii  Observe how well the Obtain work child generalizes samples using age academic information, level / adjusted age can they respond to a level curriculum question in circle time?
    68. 68. Executive Function Executive function is becoming a prominent area for assessment and intervention for a range of neuro-developmental disorders, in particular, ASD. Difficult to evaluate in children younger than 5. Areas to assess: planning and organization, anticipating an event and preparing for it, ie.,forming goals, and strategies to reach them, attention, memory processing, cognitive flexibility, cognitive planning.
    69. 69. Assessment of ExecutiveFunction Behavioral Rating  Cognitive Inventory of Executive Function (BRIEF), 5 and Assessment System up (CAS)-ages 5 and Conner’s-for Attention up-Attention Scale issues, ages 3-5  Tower Tasks DAS-2 working memory ages 5 and up  Wisconsin Card NEPSY Developmental Sorting Test Neuropsychological  Reference (Ozonoff Assessment- Attention/Concentration and Schetter) Scale
    70. 70. Sensori-Integration SI is an important area to assess due to the high probability of SI problems--about 70% or > in ASD population. SI is related to ability to attend, adapt to new environments, fatigue, and emotional regulation. Occupational Therapists are the most qualified to assess in this area. include observing response to various sensory activities, checklists (Sensori- Integration and Praxis Test, Ayers clinic), parent interview, and natural observation.
    71. 71. HFA vs. AS: How do we tell thedifference? High functioning autism  Asperger’s is requires the same DSMIV conditions as typically not autism, however, high identified until age 7 functioning autism is or 8, and there is no characterized by higher cognitive skills, some in discernable delay in the normal or above language average range, often acquisition, and with wide scatter across typically there is cognitive domains. Definitive delay in average or above language acquisition. average intelligence.
    72. 72. Assessment Tips Find out best time of  Use preferred activities day to test (try to throughout eliminate fatigue)  Include caregiver or Use approved individual who is very motivators or reinforcers, ie., favorite familiar with the child to food or activity participate with you Give clear directions  Assess in teams of two using abbreviated to three instructions when  Plan on two to three possible assessment sessions
    73. 73. Case Study: Conner2 years 10 months  Team strategies and Parent referral approach  Four sessions, parent Ambivalent about present throughout delays  Talked with parent prior Conflicted about to IEP getting a dx  Presented possibilities Very young parents, and concerns for parent to consider first child
    74. 74. Translating AssessmentInformation into FAPE Assessment data needs to be translated into:1. Identifying Unique needs2. Goals that address all areas of need3. Accommodations/supports for educational benefit4. Recommendations for programming/placement, ie., ABA/EIBT instruction
    75. 75. Unique Needs What does the assessment data indicate are unique needs of the child? Deficit areas/weaknesses Areas directly related to educational benefit, ie., those skills needed to benefit from education Needs related to learning, accessing curriculum and instruction, accessing their environment
    76. 76. Goals - The Hallmark of a GoodIEP Good goals indicate a quality assessment and knowledgeable team Goals are the driving force behind rationale for services, accommodations and supports ASD goals need to be comprehensive, intensive, and designed with a developmentally sequenced curriculum Refer to Curriculum Assessment Sheet developed by Patty Schetter, ABTA
    77. 77. Goal activity Refer to Sample Goals Look at a set of unique needs and determine what type of goals will effectively address the needs Goals set a trajectory for progress How can we make goals meaningful?
    78. 78. Rationale for Services/Supports  General education opportunities  Specialized Academic Instruction  Individual Instruction, IA support  Need for intensity, ratio of adult to child  Need for ABA approach or other  DIS services - is the model collaborative, individual, both?
    79. 79. Rationale and LRE Criticalto know what empirically based practices (EPBs) are and provide clear direction for how these can be delivered, and in what setting they can most be effective in. Does the child’s needs require a degree of intensity such as one to one and small group with highly controlled environment? Or is the child able to observe and attend to small and large group instruction and generalize skills in group settings?
    80. 80. Accommodations and Supports  Small group  Instructional Assitant  Verbal cues  Visual supports  Sensory breaks  BSP/BIP?  Visual schedule  Clear routine  Alternative communication-PECS
    81. 81. FAPE Considerations: Data needs to back up recommendations and provide rationale for placement considerations Need to consider a full range of continuum of options Tie goals to services - ie., functional communication needs/goals require …
    82. 82. FAPE considerations cont. Tie unique needs to program components-what is a good fit or match to these needs? Have clear descriptions of supports/accommodations program can provide, ie., good ratios, 1:1, developmentally sequenced curriculum, systematic instruction,etc.
    83. 83. National Autism Center Resources: Educator’s ManualEvidenced Based Practices, National Standards Project
    84. 84. Established Treatments from National StandardsProject:◖◖ Antecedent Package◖◖ Behavioral Package◖◖ Comprehensive Behavioral Treatment for YoungChildren◖◖ Joint Attention Intervention◖◖ Modeling◖◖ Naturalistic Teaching Strategies◖◖ Peer Training Package◖◖ Pivotal Response Treatment◖◖ Schedules◖◖ Self-management◖◖ Story-based Intervention Package
    85. 85. National ProfessionalDevelopment Center On AutismSpectrum Disorders What are Evidence-Based Practices (EBP)?While many interventions for autism exist, only some have been shown to be effective through scientific research. Interventions that researchers have shown to be effective are called evidence-based practices. The NPDC has identified 24 evidence-based practices.
    86. 86. View NPDC Websitehttp://autismpdc.fpg.unc.edu
    87. 87. The Report  Consider team report- pros & cons  Reports need to provide specificity, be comprehensive yet readable for parent  Clear headings, meaningful sequence  Clear summary and conclusions  Clear recommendations for IEP team to use in determining FAPE
    88. 88. Journey of Hope: Parent InterviewListen to the core message of this parent and reflect on your practice of working with parents.
    89. 89. Parent Collaboration Establish a positive rapport at the earliest point possible in the referral process Explain the roles of each examiner, and explain what the assessment process will look like and the IEP process Find out what the parent’s interests are
    90. 90. Parent Input Find out their long term goals are Establish shared interests based on the child’s needs Establish common goals Refrain from making assumptions Provide frequent follow-up and an established routine of communication
    91. 91. Parent Collaboration cont.: Provide regularly scheduled communications, such as quarterly review dates, monthly phone call, weekly note home. When things get diverted, bracket knee jerk reactions, and redirect the discussion to the child’s needs and goals.
    92. 92. Parent Input cont. Acknowledge parent concerns and needs -- communicate that you want to understand their perspective so that you can work jointly on behalf of their child. Emphasize areas in which there is agreement and areas of common interest.
    93. 93. Parent Perspective Important to convey to a parent that their input is valued-How do we do this? This is their child for the rest of their lives - the issues for them are truly intense Parents feel an urgency - they are in a crisis For a parent, trust is the most critical aspect, with trust you can move forward Building relationships is critical to any successful team - even when there is disagreement
    94. 94. When there isdisagreement Remember, there is no “winner” in an argument Goal is to maintain a positive relationship Shift from a framework that is argumentative to one that is trying to gain common understanding of the child Look for opportunities to build agreement Recognize when there is not agreement and provide an environment where this is okay Recognize when mediation will be helpful
    95. 95. Parent shoes Put yourself in the parent’s shoes - relate to having a child with an ASD like you would having a child or spouse with a life threatening disease or illness -- what are your likely emotions, actions, and needs?
    96. 96. Teaming: What does it mean? Define “team” Reflect on positive team experiences: what were the core elements of that experience? What are effective “team” behaviors? What are the key characteristics of a strong team?
    97. 97. Your Team: Next Steps Identify three goals in the next three weeks What are potential barriers or road blocks? What strengths do you bring to your team? -- dyad exercise
    98. 98. It’s the Journey not theDestination  The assessment process is like a journey, discovering unique needs, learning about families, and continuous new challenges as well as successes.

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